Provider Demographics
NPI:1700076262
Name:MGC PHARMACY LLC
Entity Type:Organization
Organization Name:MGC PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY OWNER/ MANAGER ON RECORD
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFONSO-SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD MSC
Authorized Official - Phone:305-586-6443
Mailing Address - Street 1:1516 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-3159
Mailing Address - Country:US
Mailing Address - Phone:305-586-6443
Mailing Address - Fax:305-884-7454
Practice Address - Street 1:1516 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3159
Practice Address - Country:US
Practice Address - Phone:305-586-6443
Practice Address - Fax:305-884-7454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH22923OtherPHARMACY
FL6443600001Medicare NSC